KOLEJ SAINS KESIHATAN BERSEKUTU

KUCHING, SARAWAK

KAJIAN KES
(SURGERY)

IDRUS UNGKIR DEE
710213-12-5285
PB 1 / 2009-1320

ADVANCE EMERGENCY MEDICAL
AND
TRAUMA CARE PROGRAMME

KOLEJ SAINS KESIHATAN BERSEKUTU KUCHING

AEMTC

PROGRAM ADVANCE EMERGENCY MEDICAL AND TRAUMA CARE

BAHAGIAN 1 : Maklumat Peribadi Pesakit

No. Pendaftaran : 2009/011834 KPT: 830519-13-6055
Nama : Masri Bin Bakri Pekerjaan : Buruh
Bangsa : Malayu Jantina : Lelaki Umur : 32 tahun Status : Bujang
Alamat : No.74.Kpg Hulu, Maludam, 94850,Sibuyau. Wad : Surgery
Tarikh Masuk Hospital : 12.05.2009 Tarikh Keluar Hospital : -
Pengesahan Ketua Jururawat / Staf Klinikal mengenai kesahihan butir-butir yang tersebut di atas

BETUL / TIDAK BETUL * Tandatangan :.........................................
Nama & Cop :

BAHAGIAN 2 : Maklumat Mengenai Pengkajian Kes

Nama Pelatih : IDRUS UNGKIR DEE
No. Matrik : PB 1/ 2009-1320
Keputusan : Baik (70% ke atas), Memuaskan (50-69%), Tidak Memuaskan (kurang 50%)*
Ulasan :

Tandatangan Pengajar : Tarikh Diterima: Tarikh Disemak:

Nama & Cop: Tarikh Dikembalikan:

Untuk Kegunaan
Pejabat
Nombor Matrik: PB 1 2009/1320 No. Dafter PK: KPP/PK ID PK
Nama Pelatih: IDRUS .U. DEE Diagnosis : IRREDUSABLE LT. INGUINAL HERNIA
Keputusan : Baik (70% ke atas), Memuaskan (50-69%), Tidak Memuaskan (kurang 50%)*

Tarikh Diterima: Tarikh Disemak:
Tandatangan Pengajar :

Nama & Cop : Tarikh Dikembalikan:

( Bahagian ini harus dihantar kepada Pengajar PP Kanan Asas )

25

.4: Pekerjaan : Buruh 2...3.....2.10. Tarikh Masuk Hospital : 12.. Bangsa : Malayu 2.5.. Note: Kajian kes juga boleh ditulis dalam bahasa Inggeris..1.. Maludam.........05... Tandatangan :.3. Alamat : No.6... No...... Tahun Pengambilan : 01/2009 1...45am 2..1.05....6. 94850. No.. Wad : Surgical 1.........74.. Tarikh : 12..2009 / Masa : 09............. Tarikh Penyerahan / Penerimaan Pengkajian Kes: Ulasan Pengajar : Baik / Memuaskan / Tidak Memuaskan* *potong yang tidak berkenaan..... Hospital : Hospital Umum Sarawak 1.........2009 BAHAGIAN 2 : Maklumat Peribadi Pesakit 2. AEMTC *potong yang tidak beerkenaan KOLEJ SAINS KESIHATAN BERSEKUTU KUCHING PROGRAM ADVANCE EMERGENCY MEDICAL AND TRAUMA CARE PENGKAJIAN KES BAHAGIAN 1 1.. Kampung Hulu. Jantina : Lelaki 2.5. Nama : Masri Bin Bakri 2. BETUL / TIDAK BETUL* Nama :.. Pendaftaran: 2009/011834 / KPT:760626-13-5191 2...9......... 25 .. Pengkajian Kes : 03 1.8: Status : Bujang 2.. Umur : 32 tahun 2..7...........1. Sebuyau.. Tarikh Keluar Hospital : ... Nama Pelatih : Idrus Ungkir Dee 1... __________________________________________________________________________ 2...4...... / Masa : - ___________________________________________________________________________ Pengesahan Ketua Jururawat/Jururawat Yang Menjaga Wad mengenai kesahihan butir-butir pesakit.......

6 FAMILY HISTORY  Patient is second from three siblings.7 SOCIAL HISTORY  Patient is single and currently staying with his parents.  No abnormality in bowel or urinary habit. 1.  Not known any medical / surgical history among family members. _________________________________________________________________________ 25 . 1. 1.  No history of any allergies.  Smoker: 1 packet per day since 5 years ago.  No vomiting and nauseated. 1.  Alcohol drinker: 5 cans of beer per week since 3 years ago. o Shape: Round shape o Tenderness: Mild tenderness.  No history of any medical illnesses.  History of carrying heavy load since patient working as a fisherman.  Working as fisherman.  Currently the swelling was reducible but had one episode of irreducible on April. 2009.  No abdominal pain.4 HISTORY OF PRESENT ILLNESS  Swelling: o Size: Size of an egg.  Deny having chronic cough and constipation.  Good oral intake. o Mobility : Redusible o Pulsatile nature : Cough impulse positive  No history of trauma or fall prior to the swelling.5 PAST MEDICAL / SURGICAL HISTORY  History of Right Inguinal Hernia with repaired done about 10 years ago.1 CHIEF COMPLAIN  Left inguinal swelling for one year. AEMTC PART 1 PATIENT’S HISTORY 1.

o No discharged at both ears. 2.  Palpation o No tenderness and mass. AEMTC PART 2 PHYSICAL EXAMINATION 2.2 EYES  Inspection o No swelling.4 NOSE  Inspection o Normal in shape o No bleeding / discharged  Palpation o No tenderness.1 HEAD  Inspection o No swelling or bleeding noted.  Good hydration. 2.2.  No hearing impairment. 2.  Palpation o No periorbital tenderness.2 PHYSICAL 2. o No blurring of vision. o Both pupils equal and react to light (BPEARL). Alert  Not tachypnoeic not in respiratory distress. o No hematoma.2. o Tympanic membrane intact.  Vital signs on arrival are: o GCS : 15/15 o Blood Pressure : 140/90 mmHg o Respiration Rate : 20 / minute o Pulse : 80 / minute o SpO2 : 98% (room temperature) o Temperature : 37 degree centigrade 2.2.  No pallor and central cyanosis noted.2.3 EARS  Inspection o No bleeding.1 GENERAL  Patient was in pain. 25 .  Palpation o No swelling.

2. 2.7 NECK  Inspection o No abnormality in shape o No swelling o No neck stiffness.8 RESPIRATORY SYSTEM  Inspection o No hematoma / bruises on chest. o Air entry equal bilaterally. No crepetations.2.  Palpation o Trachea not deviated.  Percussion o Normal resonance at both lungs. o Equal chest movement on inspiration and expiration. o No displacement of mediastinum.  Auscultation o No ronchi.2. o Trachea not deviated o Able to swallowed  Palpation o No tenderness o No mass palpable o No lymph node swelling o Carotid pulse palpable 2.6 MOUTH  Inspection o Normal in shape o No bleeding from gum o Not wearing dentures o Lips dry with central cyanosis 2.5 THROAT  Inspection o Not inflamed o Tonsil not enlarged / injected o No foreign body seen 2.9 CARDIOVASCULAR SYSTEM  Inspection o No non surgical or surgical wound. 25 .2.2. o No tenderness on the chest. o No vocal fremitus. AEMTC 2.

o No wound. o Pulse (Radial):  80 beat per minute. o No dilated vein seen.2.  Percussion o Normal resonance.  Reducible  Cough impulse present  Tender over the swelling area.  Auscultation o Bowel sound present: 6 times per minute o No bruit sound heard.11 GENITALIA 25 .2. o No fluid thrill.  Not extending to scrotum.  Palpation o Apex beat at 5th intercostals space midclavicular line. o Abdomen soft o Non tender.  Regular beat.  Reducible.  Auscultation o Heart rate was 80 beat per minute.  Cough impulse present.  Strong. o No surgical scar seen. 2. o No hepatospleenomegaly felt. AEMTC o No abnormalities seen. o Not distended. regular and strong.  Palpation o Left inguinal hernia.  No sign of strangulation or obstruction.  Percussion o Normal cardiac dullness.10 ABDOMEN  Inspection o Left inguinal hernia noted. o Scafoid in shape. o Dual rhythm no murmur 2.

13 PELVIC  Inspection o Nothing abnormality noted.  No pitting oedema. Lower Extremity Right Left Muscle Tone Normatania Normatania Muscle Power* 5/5 5/5 25 . o Able to move both hands without restrictions.  Posterior tibia artery and dorsalis pedis artery are palpable. 2. Biseps 2+ 2+ b.15 LOWER EXTREMITIES (RIGHT AND LEFT) o Right Leg & Left Leg  No deformity / abnormality detected.  No loss of sensation.2.12 RECTUM o Physical examination not done.  Capillary refill 2 seconds. Wrise Refleks** a.2. 2. Triseps 2+ 2+ c.1 Result Of Patient’s Muscle And Tendon Reflexes For Upper Extremities 2.2. 2.  Palpation o Nothing abnormality noted. Upper Extremity Right Left Muscle Tone Normatania Normatania Muscle Power* a. Shoulder 5/5 5/5 b. AEMTC o Left scrotal hydrocele noted.2. Elbow c.  Able to move right leg without restriction. Brachioradialis 2+ 2+ Sensation Test Intact Intact Table 2.14 UPPER EXTREMITIES (RIGHT AND LEFT) o No deformity / abnormality seen.

complete paralysis Table 2. Angkle Jirk ++ ++ d. but patient can overcome resistance applied by examiner 3 Patient can overcome gravity (can lift extremities) but cannot overcome resistance applied by examiner 2 Weak muscle contraction. AEMTC a.2 Result Of Patient’s Muscle And Tendon Reflexes For Lower Extremitie SCORE DESCRIPTION 5 Normal power or muscle strenght in extremities 4 Weak extremities. but cannot lift extremities) 1 Palpable or visible muscle flicker or twitch. more brisk than average deep 4+ Hyperactive.3 Muscle Strength Scale* SCORE DESCRIPTION Table 0 Absent 2. Hips Refleks** b. in pain.clear ENT -Pink t cyanosis. but no movement 0 No response to stimulus. GCS: 15/15 EYES RESPIRATORY -no hematoma .4 1+ Disminished Scale 2+ Normal for 3+ Increased.trachea not shifted 25 . Plantar Refleks ++ ++ Sensation Test Intact Intact Table 2.no -equal air entry -no -both pupil equel swelling & react to light -no bleeding CARDOIVASCULAR NECK -DRNM -Normal shape -regular heart beat -JVP not raised . clonus tendon reflexes** _____________________________________________________________________________ PART 3 SUMMARIES AND RELEVAN IMPORTANT FINDING General Condition: Alert. Quadriceps ++ ++ c. but not enough to overcome gravity (movement.

-tender.scrotal UPPER present. -bowel sound present -Lt. -not extendig to scrotum.non tender. GENETALIA -Cough impulse -Lt.  Differentials Diagnosis: o Strangulated Left Inguinal Hernia ______________________________________________________________________________ PART 5 BLOOD INVESTIGATIONS AND X-RAY FINDING 5.1 BLOOD UREA SERUM ELECTROLITE (BUSE)  Blood Urea Nitrogen (BUN) o To measure how well the kidneys are working. swelling noted. kidney not palpable. Urea is a nitrogen-containing waste product that's created when the body breaks down protein. -reduceble. AEMTC ABDOMEN -schafoid -soft. -liver. (right & left) -no defomity -ROM full -capillary refill <2sec Posterior tibia artery palpable LOWER EXTREMITIES (right & left) -no defomity -ROM full -capillary refill <2sec Dorsalis pedis ______________________________________________________________________________________________ artry palpable PART 4 DIAGNOSIS  Provisional Diagnosis: o Indirect Left Inguinal Hernia.spleen. EXTREMITIES (hydrocele). If the 25 . Inguinal hernia noted.

The sodium levels are measured to detect whether there's the right balance of sodium and liquid in the blood to carry out those functions. the levels of BUN will build up in the blood.200 BUSE 9 Test Result unit Normal Range NA 138 mmol/L 135 -145 25 . and even to have seizures. AEMTC kidneys are not working properly. Date : 13. The kidneys filter and excrete creatinine. o If a child becomes dehydrated because of vomiting. and lethargic. like sodium. Potassium levels that are too high or too low can increase the risk of an abnormal heartbeat. Low potassium levels are also associated with muscle weakness. creatinine can build up in the bloodstream.  Serum Electrolytes (SE) o Typically. like transmitting electrical signals in the brain and in the muscles. which can cause a child to feel confused. o Chloride (CHLO). the passage of sodium in and out of cells is necessary for many body functions. Dehydration and excessive bleeding can also elevate the BUN levels in the blood. chloride. the sodium levels can be abnormally high or low. potassium. Both dehydration and muscle damage also can raise creatinine levels. the blood may become more acidic and prevent certain chemical reactions from occurring in the body that are necessary it to keep working properly. and bicarbonate in the body. helps maintain a balance of fluids in the body. diarrhoea. or inadequate fluid intake. o Creatinine (CREAT) levels in the blood that are too high can indicate that the kidneys aren't working properly. tests for electrolytes measure levels of sodium. o Sodium (NA) plays a major role in regulating the amount of water in the body. Also. If there's a large loss of chloride. if they're not functioning properly. o Potassium (K) is essential to regulate how the heart beats.05. weak.

85 10 / ul 4.3 mmol/L 3. Sometimes a high red blood cell count is due to dehydration.  Platlet (PLT) o To evaluate the anti coagulation factor in the blood.  Total White Cells (WBC) o To determine infection. AEMTC K 3.  Heamoglobin (Hb) o To determine any changes in patient’s heamoglobin such as low Hb so called aneamia that indicates blood loss (internal or external) and Polycythaemia which is associated with an abnormally high haemoglobin concentration in the blood.7 – 8. as blood travels throughout the whole body.4 g/dl 12. An FBC not only tests for disorders and abnormalities of the blood but.13 HGB 17. 5.1 Patient’s BUSE Result  Interpretation: o All results are within normal range.3 – 5.90 Table 5.1 mmol/L 1.44pm) Test Result Unit Normal Range 3 WBC 8.3 CREAT 75 umol/L 40 . to a tumour. This could be due to respiratory or circulatory disorders or.2 Patient’s Full Blood Count Result  Interpretation: o All results are within normal range.424 Table 5.1 CHLO 99 mmol/L 98 – 107 UREA| 4.0 – 10 6 RBC 5.2 – 18.2 FULL BLOOD COUNT (FBC)  A full blood count (FBC) is a very common clinical procedure and often the “starting point” for most medical investigations.2009 FULL BLOOD COUNT RESULT (02. it can give an indication of disease present in other organs. 25 .1 3 PLT 235 10 / ul 142 . and is an indication that red blood cell numbers are also too high.67 10 / ul 4. Date : 13.04 – 6. in some cases.05.

AIRWAY.  Left scrotal swelling due to hydrocele. 7. CIRCULATION. o Reducible swelling with positive cough impulse.  Physical examination.  Triaging was done and patient was sent to yellow zone.  Radial pulse present. o Swelling of left inguinal region. Patient can talk and was in pain. PROCEDURES.  Patient can breathing freely without difficulty. BREATHING. 5.  Swelling of the left inguinal hernia was reduce spontaneously. 9. 2.  Respiration: 20/minute. TRIAGING.  Blood pressure: 130/80mmHg. 4.  No neurological deficit noted. o Left inguinal swelling for one year. 8. 84 / minute. 3. DISABILITY. MEDICATIONS. AEMTC _____________________________________________________________________ PART 6 REASON FOR DIAGNOSIS (Accroding To Patient History And Physical Examinations Finding)  Patient history. ______________________________________________________________________________ PART 7 TREATMENT & PRIMARY EMERGENCY CARE 1. EXPOSURE  Swollen noted at left inguinal but reducible.  No obvious bleeding from the injury site or any part of the body. o Once developed one episode of irreducible left inguinal on April 2009. MONITORING  Vital signs Vital Signs Result Blood pressure 130/80 mmHg Pulse 84/ minute 25 Temperature 37o C Respiration 20 / minute SpO2 98% . 10.  Airway not blocked.  Blood and X-ray investigation was not done in Emergency and Trauma Department. INVESTIGATIONS. 6.  IV Pethidine 50mg STAT was given because patient was in pain.

__________________________________________________________________ PART 8 WAD MANAGEMENT AND PATIENT PROGRESSIONS DAY ONE @ 13. AEMTC Table 7.  Left inguinal hernia noted but reducible. 3. PHYSICAL EXAMINATION:  Lungs :  Clear and equal air entry. MEDICATIONS  Not on any medication.05. PROCEDURE  No procedure done. GENERAL CONDITION  Patient well and alert.1 Patient’s Vital Signs.  Ambulating well. MONITORING  Vital signs 25 .  Non tender. PLANNING.  Cough impulse: positive. 11.  Taking orally well.  CVS: DRNM  Abdomen:  Soft. INVESTIGATION  Blood o Full blood count o BUSE o Creatinine pending result. 2.2009 1. 6.  Admission to Male Surgical for left inguinal hernia repair. 4. o GSH o PT/PTT 5.

05. 7. 5. PHYSICAL EXAMINATION:  Lungs :  Clear and equal air entry. TAPP).  CVS: DRNM  Abdomen:  Soft. INVESTIGATION  Blood: Result refer to table 5.2009 1. _________________________________________________________________________ DAY TWO @ 14. AEMTC Vital Signs Result Blood pressure 140/90 mmHg Pulse 80/ minute Temperature 37o C Respiration 20 / minute SpO2 100% Table 8.  Left inguinal hernia repair tommorow.1 and 5. MEDICATIONS  Not on medication. 3. 4. 2.2. o Lapratomy Trans Abdominal Pre Peritoneal method (Lap. PROCEDURE -Seen by surgeon this morning.  Taking orally well. GENERAL CONDITION  Patient stable and comfortable. PLANNING  Encourage orally.  Non tender.  Left inguinal hernia noted but reducible. 25 .  To discuss with surgeon for further planning.  Cough impulse: positive.3 Patient’s Vital Signs.

PROCEDURE  Received call from operation theatre to cancelled operation (lap.  CVS : DRNM  Abdomen:  Soft.4 Patient’s Vital Signs. 2. MONITORING  Vital signs Vital Signs Result Blood pressure 130/80 mmHg Pulse 86/ minute Temperature 37o C Respiration 18 / minute SpO2 99% Table 8.  Cough impulse: positive.5 L/day (N/S alternate with D5%). 7.  Non tender. 25 . PLANNING  Nil by mouth at 12 midnight. AEMTC 6. 3.TAPP) due to congestion (OT was full).05. GENERAL CONDITION  Patient stable and comfortable.  IVD 2.2009 1. ___________________________________________________________________________ DAY THREE @ 15. PHYSICAL EXAMINATION:  Lungs :  Clear and equal air entry.  Left inguinal hernia noted but reducible.

MEDICATIONS o Not on medication. PLANNING  Allow orally. 6. MONITORING  Vital signs Vital Signs Result Blood pressure 100/70 mmHg Pulse 80/ minute Temperature 37o C Respiration 18 / minute SpO2 99% Table 8. ___________________________________________________________ SUMMARY OF DISEASE INGUINAL HERNIA DEFINITION 25 . AEMTC 4. ______________________________________________________________________________ FINAL DIAGNOSIS 1. 5.5 Patient’s Vital Signs. LEFT INGUINAL HERNIA (INDIRECT).  To arrange new OT date.

SYMPTOMS Some inguinal hernias don't cause any symptoms. especially if you cough or strain. SIGNS AND SYMPTOMS IN CHILDREN About five in every 100 children have inguinal hernias. especially when bending over. and you may not know you have one until your doctor discovers it during a routine medical exam. Inguinal hernia signs and symptoms include:  A bulge in the area on either side of your pubic bone. and you usually can feel it if you put your hand directly over the affected area. however. coughing or lifting . The bulge is usually more obvious when you stand upright. a hernia is likely to be more apparent when the child coughs. WHEN TO SEE A DOCTOR See your doctor if you have a painful or noticeable bulge in the area on either side of your pubic bone. The bulge is likely to be more noticeable when you're standing upright. In an older child. pain and swelling in the scrotum around the testicles when the protruding intestine descends into the scrotum. Often.  A heavy or dragging sensation in your groin. strains during a bowel movement or stands for a long period of time. 25 . you can see and feel the bulge created by the protruding intestine. bend over or lift a heavy object. coughing or straining during a bowel movement.  Pain or discomfort in your groin.  Occasionally. Sometimes the hernia may be visible only when an infant is crying. AEMTC Inguinal hernias occur when soft tissue usually part of the intestine protrudes through a weak point or tear in your lower abdominal wall. The resulting bulge can be painful especially when we cough. Inguinal hernias in newborns and children result from a weakness in the abdominal wall that's present at birth. in men.

the weak spot usually occurs along the inguinal canal. In the male fetus. the abdominal wall weakness that leads to an inguinal hernia occurs at birth when the abdominal lining (peritoneum) doesn't close properly. the tube that carries sperm. the testicles form within the abdomen and then move down the inguinal canal into the scrotum. purple or dark. enters the scrotum. If not. applying an ice pack to the area may reduce the swelling enough so that the hernia slides in easily. If you still aren't able to push the hernia in. vomiting or a fever. This condition may be accompanied by nausea. the herniated intestine may have become trapped (incarcerated) in the abdominal wall — a serious condition that may require immediate medical attention. In men. CAUSES Some inguinal hernias have no apparent cause. leaving just enough room for the spermatic cord to pass through. but not large enough to allow the testicles to move back into the abdomen. If any of these signs or symptoms occur. 25 . In women. Lying with your pelvis higher than your head also may help. and hernias sometimes occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone. call your doctor right away. Shortly after birth. MORE COMMON IN MEN Men are more likely to have an inherent weakness along the inguinal canal because of the way males develop in the womb. the inguinal canal carries a ligament that helps hold the uterus in place. strenuous physical activity or coughing that accompanies smoking. But many occur as a result of:  Increased pressure within the abdomen  A pre-existing weak spot in the abdominal wall  A combination of the two In many people. which contains the vas deferens. AEMTC You should be able to gently and easily push the hernia back into your abdomen when you're lying down. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to factors such as aging. and a hernia bulge that turns red. the inguinal canal closes almost completely. This is the area where the spermatic cord.

Weaknesses can also occur in the abdominal wall later in life. women are more likely to develop hernias in the femoral canal. Nearly 10 times more men than women have inguinal hernias. Whether or not you have a pre-existing weakness. There's less chance that the inguinal canal won't close after birth in female babies. a life-threatening disorder that causes severe lung damage and often a chronic cough. such as a parent or sibling. Your risk of inguinal hernia increases if you have a close relative. leaving a weakened area. Other risk factors include:  Family history. the canal doesn't close properly. especially after an injury or certain operations in the abdominal cavity. vein and nerve pass through. Having cystic fibrosis. RISK FACTORS You're far more likely to develop an inguinal hernia if you're male.  Certain medical conditions. however. with the condition. AEMTC Sometimes. makes it more likely you'll develop an inguinal hernia. and the vast majority of newborns and children with inguinal hernias are boys. This pressure may result from:  Straining during bowel movements or urination  Heavy lifting  Fluid in the abdomen (ascites)  Pregnancy  Excess weight Even chronic coughing or sneezing can cause abdominal muscles to tear. 25 . an opening near the inguinal canal where the femoral artery. extra pressure in your abdomen can cause a hernia. In fact.

Having a job that requires standing for long periods or doing heavy physical labor increases your risk of developing an inguinal hernia.  Certain occupations. Large hernias can put pressure on surrounding tissues in men they may extend into the scrotum. Being moderately to severely overweight can put extra pressure on your abdomen.  Excess weight. It can also diminish blood flow to the trapped portion of the intestine a condition called strangulation that may lead to the death of the affected bowel tissues. A strangulated hernia is life- threatening and requires immediate surgery.  Pregnancy.  History of hernias. This may obstruct the bowel. Infants who are born sooner than normal are more likely to have inguinal hernias.  Chronic constipation. vomiting and the inability to have a bowel movement or pass gas. AEMTC  Chronic cough. 25 . If you've had one inguinal hernia. it's much more likely that you'll eventually develop another usually on the opposite side.  Premature birth. This leads to straining during bowel movements — a common cause of inguinal hernias. increases your risk of inguinal hernia. But the most serious complication of an inguinal hernia occurs when a loop of intestine becomes trapped in the weak point in the abdominal wall (incarcerated hernia). causing pain and swelling. such as occurs from smoking. A chronic cough. This can both weaken the abdominal muscles and cause increased pressure inside your abdomen. COMPLICATIONS Most inguinal hernias enlarge over time if they're not repaired surgically. nausea. leading to severe pain.

TREATMENTS AND DRUGS If your hernia is small and isn't bothering you. your doctor may recommend a watch-and-wait approach. using several small incisions rather than one large one. 25 . your surgeon inserts a piece of synthetic mesh to cover the entire inguinal area. which is something like patching a tire. Hernioplasty can be performed conventionally. Because coughing can make a hernia more prominent. but it may be as long as four to six weeks before you're able to fully resume your normal activities. then repairs the weakened or torn muscle by sewing it together. In this procedure. clips or staples. A fiber-optic tube with a tiny camera is inserted into your abdomen through one incision. It's also good for people who have hernias on both sides of the body (bilateral inguinal hernias). But it's often done laparoscopically. After the operation. you may be asked to cough or strain as part of the exam. But enlarging or painful hernias usually require surgical repair to relieve discomfort and prevent serious complications. These risks are reduced if the procedure is performed by a surgeon with extensive experience in these kinds of repairs. The patch is usually secured with sutures. Disadvantages of laparoscopic repair include an increased risk of complications and of recurrence following surgery. Your surgeon then performs the operation using the video camera as a guide. and miniature instruments are inserted through the other incisions. with a single long incision over the hernia. AEMTC TESTS AND DIAGNOSIS A physical exam is usually all that's needed to diagnose an inguinal hernia. including all potential hernia openings. The procedure is a good choice for people whose hernias recur following traditional hernia surgery because laparoscopic methods allow surgeons to work around scar tissue from earlier repair. Your doctor is likely to ask about your signs and symptoms and to check for a bulge in the groin area. In this procedure. There are two general types of hernia operations:  Herniorrhaphy. you'll be encouraged to move about as soon as possible.  Hernioplasty. your surgeon makes an incision in your groin and pushes the protruding intestine back into your abdomen. Advantages of laparoscopic repair include less discomfort and scarring after surgery and a quicker return to normal activities — most people are back to work within a few days.

but the following steps can help reduce strain on your abdominal muscles and tissues:  Maintain a healthy weight. If you think you may be overweight. not from your waist.  Lift heavy objects carefully or avoid heavy lifting altogether. They're also packed with fiber that can help prevent constipation and straining. Fresh fruits and vegetables and whole grains are good for your overall health. wearing a truss isn't the best long-term solution for an inguinal hernia. PREVENTION You can't prevent the congenital defect that may lead to an inguinal hernia. emphysema and heart disease. talk to your doctor about the best exercise and diet plan for you.  Don't rely on a truss for support. In addition to increasing your risk of serious diseases such as cancer. if your intestine is pushed down into the scrotum or if you've had previous pelvic surgery such as a prostatectomy.  Stop smoking. ______________________________________________________________________________________________ 25 . Contrary to what you may have heard. always bend from your knees. A truss won't protect against complications or correct the underlying problem.  Emphasize high-fiber foods. smoking often causes a chronic cough that can lead to or aggravate an inguinal hernia. If you have to lift something heavy. although your doctor may recommend wearing one for a short time before surgery. AEMTC You may not be a candidate for laparoscopic hernia repair if you have a very large hernia.

AEMTC 25 .